Q: I am 100 pounds overweight, and I saw a doctor on television promoting the use of Garcinia cambogia for weight loss. I am 65 years old and, because of cancer, I underwent a radical nephrectomy and have only one kidney. I suffer from neuropathy and must use a cane for balance when I walk. I have Type 2 diabetes, but am monitoring my blood sugar and have it fairly well under control. However, I really need to try to shed some weight, and because of my lousy physical condition, exercise isn’t much of an option. What about Garcinia? Will the liver or the kidney would process the pills? I am on several different medications for diabetes, gout, high blood pressure, etc.

A: I am pretty conservative about new treatments and wait for well-done studies to prove effectiveness, and Garcinia doesn’t have that. The current enthusiasm for Garcinia may be warranted, but I can’t recommend it yet.

There are reports of liver but not kidney damage from Garcinia, as far as I can tell. If you choose to take it, you should use the lower end of the dose range.

Also, I see many people on medications for diabetes, and many of them, especially insulin and glyburide, make it harder to lose weight. Talk to your diabetes doctor about some newer options that may make it easier to lose weight. Exenatide (Byetta) and similar medications might be right for you, but only your doctor knows enough about you to help you make that decision.

Often, we doctors don’t think as much as we should about the weight effects of medications.

At 100 pounds overweight, the most effective treatment for you is weight-loss surgery. It is highly effective at treating diabetes, but it isn’t right for everybody.

Q : My husband drinks tonic water with quinine every day. He drinks as much as 1 1/2 quarts a day. Is that much safe? The reason he drinks so much is because he gets leg cramps and he was told that tonic water with quinine will help alleviate the cramps.

A: Many people have found that quinine relieves leg cramps. However, the Food and Drug Administration banned sales of quinine for leg cramps due to unproven effectiveness and the possibility of side effects. Quinine in large doses can cause abnormal heart rhythms, blood problems and even organ failure.

However, the amount of quinine in tonic water is quite small, compared with quinine tablets. One common brand has 17 mg in a liter, so your husband is getting about 25 mg. The quinine tablets formerly prescribed for leg cramps were 200 mg. Toxic effects are unlikely at the dose in quinine water.

Some people are allergic to quinine, in which case even the small dose in tonic water could potentially cause problems. Your husband can keep on as he has been doing if he finds that it helps.

Q: When I was discharged from the Army in 1966, I was diagnosed with a heart murmur. It seemed to be insignificant; how-ever, in April 2011, during a routine exam, I was diagnosed with atrial fibrillation, admitted to the hospital and had a cardioversion. Since then, I have had numerous problems with my heart, including a blood clot. Could the atrial fibrillation have been caused by the heart murmur?

A: A heart murmur is a noise made by the heart that is heard during examination. Many heart murmurs are “functional” or “innocent”: The examiner can hear the blood flowing through a normal valve. These are more common in thinner people or people with a high metabolic rate. Murmurs also can indicate diseased heart valves or abnormal connections (“holes”) in the heart.

Depending on how the murmur sounds, the doctor may choose to obtain an echocardiogram to see whether there is anything wrong. This wasn’t available in 1966, but it’s routine now to get an echo for a worrisome heart murmur.

All four valves in the heart can cause murmurs, either from a too-tight valve opening (“stenosis”) or a valve that leaks when closed (“regurgitation” or “insufficiency”). Disease of the mitral valve, which connects the left atrium and the left ventricle, can cause gradual enlargement of the left atrium. As the atrium enlarges, it becomes susceptible to atrial fibrillation, with its attendant risk of clots.

A history of rheumatic fever is the most important risk factor for development of mitral stenosis (a narrowing of the mitral valve); however, many people are unaware of having had it. There are other causes, including congenital mitral stenosis.

So, yes, it’s possible that the same underlying cause was responsible for your heart murmur more than 50 years ago and your atrial fibrillation now. I would have expected some doctor or nurse listening to your heart between now and then to have heard the murmur again and gotten an echo, so it also is possible that you just happened to have a heart murmur back then and developed atrial fibrillation for some other reason years later.

Q: What is a hammer toe? Is surgery always necessary?

A: A hammer toe is a deformity of the second, third or fourth toe, where it stays permanently bent. It may be caused from wearing shoes with too little toe room.

Roomy shoes are always a good idea, and taping may be tried if the toe is still bendable.

Surgery is used in cases of pain that doesn’t respond to conservative treatments. Surgery should not be done just for cosmetic reasons.

A: I think it makes sense to limit sugar intake, as most North Americans take in remarkably large quantities of sugar. Recently, while giving a lecture at the medical school, I noticed that the carbonated sodas served contained 45 grams of added sugar per can. That’s more than the American Heart Association recommends in a day (no more than 25 grams of added sugar per day for women, 40 grams a day for men). Be wary of products that claim to be sweetened by fruit juice or fruit sugar; this still counts as added sugar.

I do make an exception for fruits, as the body processes natural sugars from fruit differently.

Although reducing sugar is critical for diabetics and is very important for anyone trying to lose weight, even for people with no sugar or weight problems, the evidence is accumulating that eating too much added sugar increases future risk for heart disease and diabetes.

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